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Joint Replacement: When Medicine and Physical Therapy Aren’t Enough

Imagine that you can’t run, walk or even stand without experiencing pain in your knees. Maybe your hips hurt so bad it’s all you can do to get out of bed in the morning. Millions of Americans experience varying degrees of joint pain due to arthritis or injury, but if you’re one of them, it doesn’t mean you have to sit out life on the sidelines.

Physicians such as Karim Elsharkawy, M.D., an orthopedic surgeon at Texas Center for Joint Replacement, a Texas Health Physicians Group practice, work every day to get North Texans back on their feet through a combination of therapy, medications and, in the more advanced cases, surgery. Elsharkawy sees patients in different stages of joint pain, from those with occasional flare-ups to others needing total joint-replacement surgery.

“We see patients in different age ranges experiencing joint pain, some of which is activity-related without structural damage or evidence of arthritis,” Elsharkawy says. “The pain is usually secondary to muscle or ligament sprain, strain or overuse. In such cases, the individuals can generally return to their normal lifestyle with activity modifications, anti-inflammatory medications and rest.”

“Another group of patients has more joint damage and findings of arthritis both clinically and on X-rays. However, their symptoms are occasional and do not affect their quality of life. In that subset of patients we opt for non-surgical conservative treatment, which includes anti-inflammatory medications, steroid and gel injections, activity modifications, and/or physical therapy. When these measures fail to bring sufficient relief and the joint pain is interfering with quality of life, we may offer joint replacement surgery,” he adds.

One other group seen by Elsharkawy and his colleagues is comprised of patients with advanced arthritis who have tried non-surgical treatment for an extended period of time without improvement in their symptoms. The pain and disability are taking their toll on quality of life so the next step for these patients is joint-replacement surgery.

“I’m generally conservative in my approach, and surgery is not the first option,” he says. “I tell my patients all the time that ‘I operate on you, not on your X-rays’. The patient dealing with arthritis for some time is the best person to know when it’s time for a fix; when they can’t get any relief with other treatment measures.

When joints start to wear out, there just aren’t a lot of good options. And as of now, when cartilage is damaged and worn, we have no way of regenerating it or bringing it back. The treatment is basically geared toward their symptoms, whether it’s non-surgical treatment or eventually a joint replacement. It’s worth noting, though, that joint replacement is the only definitive cure for arthritis. All other measures are temporary and rather like putting a band aid on the joint.”

“We see both young and older people with severe end-stage arthritic changes. This is both challenging and exciting because they represent two different categories with different expectations and lifestyles. Our goal is always to focus on each individual patient, trying to align our goals and their expectations to get them back to the level of activity they desire,” Elsharkawy adds.

According to the American Academy of Orthopaedic Surgeons, more than 1 million Americans received total joint replacements in 2014. And the demand for hip and knee replacements is expected to increase exponentially. By 2030, it is estimated that 635,000 total hip-replacement procedures will be performed and 1.28 million total knee-replacement procedures. Although hip and knee replacements are the most common, other joints such as the wrist, elbow, shoulder and ankle can be replaced as well.

Joint-replacement surgery involves removing the damaged cartilage and bone before replacing them with metal, plastic or ceramic prosthetic components, which replicate the damaged joint. And while a large majority of patients who undergo joint replacement report a significant improvement, maintaining realistic expectations is important.

“I believe in shared decision making and involving patients in their care,” Elsharkawy explains. “Clear communication is key for better outcomes. I try to be honest with people so they can make an informed decision with the right expectations.”

Elsharkawy also notes that patients should be in the best physical and mental shape possible before heading into surgery to limit potential complications, such as blood clots and infections, and to minimize extended recovery periods. Patients who are overweight should try to control their weight and improve their nutrition because they are often malnourished. This can have negative implications on postoperative healing. Patients with diabetes should aim to control their blood sugar levels for at least six months prior to surgery.

Improvement and control of any modifiable risk factors before surgery is always the goal. Above all, patients should ask their doctors questions about potential limitations and set reasonable post-treatment expectations.

My wife had TKR by Dr. Micheal Champine 2 yrs. ago & is still experiencing intermittent pain with Heat & Tightness on her replaced Zimmer Natural Knee Replacement .. X-Rays show no infection, yet she still has pain almost 24/7; should be No Excuses from this orthopedic surgeon & his MD. back-up .. I had same TKR from this same surgeon 4 yrs. ago, & no problems .. we are both in excellent health … RAY

Ray, I’m so sorry to hear about your wife’s pain! If you would like for us to contact you to follow up, please send a phone number to katieborders@texashealth.org along with the date and location of treatment and we will contact you. Thank you, –Sarah, Texas Health

I had a total knee replacement almost two years ago. I am 60 now and the recovery did not go as expected. My at home therapy was a total failure. I lost mobility and flexibility and the out patient physical therapy could not recover it. Now, I am facing another surgery [an athrotomy and synovectomy and possibly up to a new total knee replacement. The thigh bone is not growing into the new knee properly. I am having a different ortho surgeon do the work as my previous surgeon has retired. What are my options? Is this the best or only option?

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